Effect of Spinal Fixation in Rabbits With Metastatic Tumor Using a Novel Spinal Fusion Model
Effect of Spinal Fixation in Rabbits With Metastatic Tumor Using a Novel Spinal Fusion Model
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DOI：
10.1097/bsd.0b013e3182693f56
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发表时间：
2016-05-01
影响因子：
1.9
通讯作者：
Nakamura, Hiroaki
中科院分区：
文献类型：
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作者：
Yamada, Kentaro;Terai, Hidetomi;Nakamura, Hiroaki
研究设计：采用兔模型评价脊柱稳定性对转移瘤生长的影响。目的：探讨脊柱稳定性对兔脊柱转移瘤生长的影响。背景资料摘要：对于脊柱转移瘤患者，由背痛或截瘫引起的步态障碍与其预后相关。对于一些患者来说，姑息性手术是很好的选择；然而，合适的脊柱手术时机和方法仍然存在争议。方法：首先在18只日本大白兔的L2-L4固定椎体上测试了一种新型锁定钢板固定模型的生物力学特性。分别于0、4、8周与对照组进行生物力学和放射学检查。之后，将另外31只兔L3椎体内接种VX2肿瘤细胞，分为固定组(16只)和假手术组(15只)，以评估脊柱稳定对肿瘤生长的影响。通过动物行为、CT、脊髓造影和细胞增殖标记物(MIB-1指数)评价截瘫时间、肿瘤细胞生长和增殖情况。结果：在生物力学载荷试验中，固定节段在各个时间点的运动范围是对照组的1/8，弯曲刚度是对照组的15倍。截瘫前接种VX2癌细胞的兔未见病理性骨折，固定组与假手术组截瘫时间差异无统计学意义(分别为26.7和28d)。同样，在溶骨区扩张和肿瘤细胞增殖方面也没有差异(MIB-1指数分别为38.1%和38.0%)。结论：我们研制的兔脊柱锁定钢板内固定具有良好的生物力学性能。脊柱固定对侵袭性癌的生长及截瘫时间影响不大。然而，还需要进一步的研究来确定脊柱稳定对生长缓慢的肿瘤的影响。
Study Design: An experimental assessment of the impact of spinal stabilization on metastasis growth using a rabbit model.Objective: To investigate the influence of spinal stabilization on the growth of metastatic spinal tumors in rabbits using a novel method of spinal fusion.Summary of Background Data: For spinal metastasis patients, gait disturbances caused by back pain or paraplegia correlates with their prognosis. Palliative surgeries are good options for some patients; however, the appropriate timing and method of spinal surgery remains controversial.Methods: The biomechanical properties of a novel spinal fixation model with a locking plating system were first examined on the L2-L4 fixed vertebrae of 18 Japanese white rabbits. Biomechanical and radiographic examinations were performed at 0, 4, and 8 weeks as compared with controls. After this, another 31 rabbits were then inoculated with VX2 carcinoma cells into the L3 vertebral body and divided into fixation (N = 16) and sham (N = 15) groups to assess the impact of spinal stabilization on tumor growth. The time to paraplegia, and tumor cell growth and proliferation were evaluated by rabbit behavior, computed tomography, myelogram, and cell proliferation marker (MIB-1 index).Results: In the biomechanical loading test, fixed segments showed one eighth of the range of motion and 15 times bending stiffness as compared with controls at each timepoint. No pathologic fractures were observed in the rabbits inoculated with VX2 carcinoma cells before paraplegia, and there was no difference in the time to paraplegia between the fixation and sham groups (26.7 and 28 d, respectively). Similarly, no differences were observed in osteolytic area expansion or tumor cell proliferation (MIB-1 index; 38.1% and 38.0%, respectively).Conclusions: Our locking plate fixation of rabbit spines exhibited sufficient biomechanical properties. Spinal fixation had little influence on the growth of the aggressive carcinoma and the time to paraplegia. However, further investigation is needed to determine the influence of spinal stabilization on slow-growing tumors.